Wewnątrznaczyniowe leczenie tętniaków naczyń mózgowych przy użyciu spirali odczepianych hydraulicznie

Background: Authors analysed results of endovascular treatment using platinum hydraulically detachable coils in ruptured and unruptured cerebral aneurysms. The aim of the study was to evaluate the efficacy of the presented method and safety of the treatment for patients with cerebral aneurysms. Material/Methods: Authors describe a clinical analysis in a group of 129 patients with 153 cerebral aneurysms treated with endovascular embolization in Department of Neurosurgery and Neurotraumatology of University of Medical Sciences in Poznań, Poland. 116 patients were hospitalized with a history of subarachnoidal hemorrhage, while 13 patients were without previous onset of bleeding. In bled group the clinical condition was assessed according to Hunt-Hess's scale. All patients were treated using Balt (MDS Pression) hydraulically detachable coils system. Based on angiographic examination results one evaluated the anatomical conditions of the aneurysm, its size, and relationship of the aneurysmal sac to its neck. Considering 116 patients with ruptured aneurysms, endovascular embolization within 72 hours was performed in 70 cases, in case of 46 patients the procedure was delayed. Results: Complete occlusion of the lumen of the aneurysmal sac was achieved in 126 (82.3%) patients, while incomplete occlusion in 27 (17.7%). The efficacy of embolization was connected with the size and morphology of the aneurysm, as well as the relationship of the neck to the aneurysmal sac. Complete embolization was obtained specially in case of small aneurysms and those with a narrow neck. Conclusions: Authors proof justness of transarterial embolisation as a highly effective first choice procedure of aneurismal sack exclusion from cerebral circulation

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

Temporal changes in regulatory T cell subsets defined by the transcription factor Helios in stroke and their potential role in stroke-associated infection: a prospective case–control study

Abstract Background Regulatory T cells (Tregs) are involved in the systemic immune response after ischemic stroke. However, their role remains unclear, and the effect appears to be both neuroprotective and detrimental. Treg suppressor function may result in immunodepression and promote stroke-associated infection (SAI). Thus we assume that the bidirectional effects of Tregs may be in part attributed to the intracellular transcription factor Helios. Tregs with Helios expression (H+ Tregs) constitute 70–90% of all Treg cells and more frequently than Helios-negative Tregs (H− Tregs) express molecules recognized as markers of Tregs with suppressor abilities. Methods and results We prospectively assessed the circulating Treg population with flow cytometry in 52 subjects on days 1, 3, 10 and 90 after ischemic stroke and we compared the results with those obtained in concurrent age-, sex- and vascular risk factor-matched controls. At all studied time points the percentage of H+ Tregs decreased in stroke subjects—D1: 69.1% p < 0.0001; D3: 62.5% (49.6–76.6), p < 0.0001; D10: 60.9% (56.5–72.9), p < 0.0001; D90: 79.2% (50.2–91.7), p = 0.014 vs. controls: 92.7% (81.9–97.0) and the percentage of H− Tregs increased accordingly. In patients with SAI the percentage of pro-suppressor H+ Tregs on post-stroke day 3 was higher than in those without infection (p = 0.03). After adjustment for confounders, the percentage of H+ Tregs on day 3 independently correlated with SAI [OR 1.29; CI 95%: 1.08–1.27); p = 0.02]. Although the percentage of H+ Tregs on day 3 correlated positively with NIHSS score on day 90 (rS = 0.62; p < 0.01) and the infarct volume at day 90 (rS = 0.58; p < 0.05), in regression analysis it was not an independent risk factor. Conclusions On the first day after stroke the proportion of H+ vs. H− Tregs changes in favor of pro-inflammatory H− Tregs, and this shift continues toward normalization when assessed on day 90. A higher percentage of pro-suppressive H+ Tregs on day 3 independently correlates with SAI and is associated positively with NIHSS score, but it does not independently affect the outcome and stroke area in the convalescent phase of stroke

Application of X-rays to dental age estimation in medico-legal practice

Aim of the study: The paper addresses the use of dental age assessment methods based on radiographs in medico-legal practice. Different cases of practical application of the methods are presented including identification of human remains, dental age assessment in a living person and one archaeological case. Material and methods : The study material consisted of cases involving dental age assessment performed in the Department of Forensic Medicine, Poznan University of Medical Sciences in Poznan. Depending on the preliminary assessment of age, the Liversidge or the Kvaal et al. methods were applied. Dental age was estimated on the basis of available pantomograms. In the case of the living person, it was a radiograph supplied for expert evaluation. In the other cases, dental computed tomography was performed. Results : Dental age was successfully estimated in all of the cases. Various methods based on the analysis of X-ray images were applied. Dental age was shown to be correlated with skeletal age. Conclusions : The methods based on radiographs were demonstrated to be useful, and the results they yield are fully correlated with results of anthropological analyses